The gunshots that filled the halls a few minutes earlier have ended, but the all-clear to bring in the EMS personnel won’t come until after the shooter has been taken from the scene and after a final check to make sure he acted alone. While minutes tick away — sometimes just a few, sometimes a couple of hours — blood continues to flow. Blood from wounds that could be life-threatening if not treated right now, by someone already on the scene. Treated by a law enforcement officer who has completed Level II ALERRT training.
“Terrorism Response Tactics – Active Shooter Level II,” the second level of the Advanced Law Enforcement Rapid Response Training Program offered by the ALERRT Training Center at Texas State University, takes officers to the next step to take after an active threat has been neutralized. “About two years ago, we realized that officers are getting really good at learning how to deal with an active threat and stop the killing, but they didn’t know how to stop the dying after they put the bad guy down. We want to give them the tools to save as many lives as we can,” says ALERRT Assistant Director Terry Nichols.
The techniques taught in the course derive from tactical combat casualty care methods developed by the U.S. Army over the past 10 years, and the Army’s Dr. Robert Mabry serves as medical adviser to the training: “The chief preventable reason why people die in combat is external hemorrhage from injuries to limbs. We’ve trained soldiers to deal with life-threatening loss of blood, and ALERRT is now teaching police officers how to pack wounds with hemostatic gauze, how to apply tourniquets, how to position people so they can breathe and not drown in their own blood. ALERRT teaches these techniques at an appropriate level for law enforcement use. We don’t need to make law enforcement officers into trauma surgeons, but we can give them effective tools so they can do what a trauma surgeon would do in the same circumstances. If you kill the bad guy, but three kids bleed to death before EMS gets there, the mission has still failed.”
Nichols says the training — which can take place in either a scheduled class at San Marcos or “on the road” at the request of a local jurisdiction — works best if firefighters and EMS personnel from the same jurisdiction all participate. The first day of the class provides instruction for students on basic medical skills including the use of tourniquets, improvising tourniquets, wound packing, bandaging and lifts/drags/carries. On the second day, students learn triage and link-up procedures, and review tactical considerations for responding to an active shooter. The class includes multiple force-on-force scenarios where officers must first stop an ongoing threat and then experience several ways of dealing with numerous injured victims, including taking the wounded out to fire and EMS as well as providing security for fire and EMS to enter a crisis site.
“The primary concept we want to enforce is what we can do immediately on the scene to save lives, which is mainly hemorrhage control. Officers also have to learn there are some injuries they can’t work on, such as a penetrating gunshot wound to the abdomen. That requires an operating room and a trauma team. They learn how to prioritize which injuries need immediate attention and which ones can wait,” Nichols says. “Active threat training is great, but this class is what happens after the shooting stops. It focuses on saving lives and integrating those efforts with fire and EMS.”
Nichols says that integration requires philosophical and policy changes, because traditionally, fire and EMS won’t enter a scene until it has been secured: “They will have to learn to let law enforcement define what is secure, to trust law enforcement to provide cover and keep them safe. It starts with having a discussion about working together and talking together. If they’ve trained together, it’s going to help build that needed trust.”
Law enforcement officers in the state of Texas who complete “Terrorism Response Tactics-Active Shooter Level II” receive a medical kit to carry in their patrol cars that includes a tourniquet, shears, hemostatic gauze, field dressings and sterile gloves. (Students from outside the state receive instructions on how to set up their own kits). One student who has already put his kit to good use is Officer John Mahoney of the New Braunfels Police Department, who found himself called to the scene of major vehicle accident in summer 2012.
Mahoney said he arrived on the scene ahead of the paramedics and found a woman who had her right leg caught between her motorcycle and the pickup truck that struck her. The victim lay on the ground bleeding from a severed major artery, and a bystander exclaimed “she’s bleeding out.”
Mahoney retrieved his medical kit and applied a tourniquet to what paramedics later termed a life-threatening injury. He received a departmental award for his efforts.
“Normally at that type of accident we would just provide traffic control, but it had been only a couple of months since I took the training, and after thinking about it for just a moment, I realized that I had the training, I had the equipment and I could help her,” Mahoney said.
“My department has encouraged everybody to take Level I Active Shooter training. After going, I learned about other classes and started taking them on my own.”